Healthcare Provider Details

I. General information

NPI: 1982967410
Provider Name (Legal Business Name): LATASHA SAFFO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 EAST 120TH ST BUILDING #14
LOS ANGELES CA
90059
US

IV. Provider business mailing address

14920 EASTWOOD AVE # C
LAWNDALE CA
90260-1723
US

V. Phone/Fax

Practice location:
  • Phone: 424-338-2739
  • Fax:
Mailing address:
  • Phone: 323-364-4278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number99008
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: